目的 分析传统临床生化检验实验课程的设置现状及存在问题,探索研究整合临床实验室资源联合PBL教学法的临床生化检验实验新教学模式.方法 调查2017年1月—2020年12月在南昌大学及其附属医院学习的医学检验专业本科学生100名及其任课教师及实验员7名,其中对照组52名,试验组55名.调查内容主要包括人员的一般资料和实验课程实施的要素和预期效果.结果 对照组和试验组的人数,年龄,性别比例在两组之间差异无统计学意义(P>0.05).对照组和试验组之间在仪器维护是否按时保养、校准品是否配套、实验场地面积是否足够、人员是否具备相应资质、实验场地是否安全要素方面差异无统计学意义(P>0.05).在仪器是否先进、试剂是否配套、质控品是否配套、实验项目是否齐全、学生兴趣是否高,项目临床意义是否掌握等方面试验组高于对照组,差异有统计学意义(P<0.05).结论 与传统的临床生化检验实验教学模式比较,资源整合联合PBL的临床生化检验实验新教学模式在培养学生临床实验技能方面具有明显优势.

目的 探讨CKMB活性法和质量法检测结果回归方程建立及临床应用.方法 对我院2017年体检正常人的25例和确诊心梗患者的35例血清同时进行CKMB活性法和质量法检测并建立两种检测结果之间的回归方程;统计分析我院临床假性升高CKMB活性法结果及回归方程在纠正假性升高CKMB活性法结果之中的作用.结果 CKMB活性法和质量法结果相关回归方程Y=0.0263X3-1.0666X2+11.72X-18.747,R2>0.9.我院一周CKMB活性法检测结果总数1883,其中CKMB>0.3CK假性升高结果数220,占比11.2％,CK-MB>CK的结果数为66,占比3.505％,CK-MB>CK>50μ/L结果数18,占比0.96％.假性升高CKMB活性法结果与经回归方程纠正结果比较,P<0.05,两者之间有显著的差异.结论 建立CKMB活性法和质量法检测结果回归方程有助于纠正假性升高CKMB活性法结果.

Objective:To investigate the predictive value of thromboelastography (TEG) for early neurological deterioration (END) in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke admitted to the Department of Neurology, Jiujiang Hospital Affiliated to Nanchang University from January 2018 to May 2019 were included as case group, and the healthy physical examinees in the same period were selected as control group. END was defined as an increase of ≥2 of the National Institutes of Health Stroke Scale score from baseline within 7 d after the onset of acute ischemic stroke. All subjects were routinely tested for traditional coagulation function, including prothrombin time, activated partial thromboplastin time, thrombin time, and plasma fibrinogen level. The reaction time (R value), coagulation time (K value), coagulation angle (α) and maximum amplitude (MA value) were monitored by TEG. Univariate analysis was used to compare the differences in clinical and laboratory results between the END group and the non-END group, and then multivariate logistic regression analysis was used to determine the independent risk factors for END. Results:A total of 96 patients with acute ischemic stroke and 20 controls were included. Compared with the control group, the traditional coagulation parameters of the case group were not significantly different. For the TEG parameter, compared with the control group, the R value and K value of the case group were significantly shortened, and the α angle and MA value were significantly increased (all P<0.05). A total of 31 patients (32.3%) developed END, and the R and K values in the END group were significantly shorter than those in the non-END group (all P<0.05). Multivariate logistic regression analysis showed that R value (odds ratio 1.192, 95% confidence interval 1.006-1.410; P=0.001) and K value (odds ratio 1.054, 95% confidence interval 1.012-1.150; P=0.001) shortening were the independent predictors of END. Conclusion:The sensitivity of TEG in the monitoring of coagulation function in patients with acute ischemic stroke is higher than that of traditional coagulation indicators. The shortenings of R and K values are independent predictor of END in patients with acute ischemic stroke.

目的：系统评价普拉克索治疗不宁腿综合征（ RLS）的临床疗效和安全性。方法检索1970年1月至2013年4月中国期刊全文数据库（ CNKI）、中国生物医学文献数据库（ CBM）、美国国立医学生物信息中心PubMed数据库（ PubMed）、Cochrane图书馆临床对照试验资料库（ CEN-TRAL）、荷兰医学文摘数据库（Embase）关于普拉克索治疗RLS随机对照研究的文献。按照纳入和排除标准选择文献，并采用 STATA12.0软件进行Meta分析。结果共纳入8个随机对照试验，合计2218例RLS患者，其中试验组1333例，对照组885例，其中4个研究方法学质量为A级，另外4个为B级。 Meta分析结果显示：①RLS改变量（IRLS评分），普拉克索组明显优于安慰剂组〔SMD＝－2.43，95％CI（－4.40，-0.46），P＜0.05〕；②反应率临床总体印改善量表评分〔（CGI-I）评分〕，普拉克索组反应率优于安慰剂组〔RR＝1.35，95％CI（1.23，1.48），P＜0.05〕；③安全性分析（不良反应事件），普拉克索组低于安慰剂组〔RR＝1.13，95％CI（1.03，1.24），P＜0.05〕。结论普拉克索能有效改善 RLS患者的症状，耐受性较好。但受到纳入文献数量限制，以上结论尚需更多高质量的临床试验进一步证实。